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Approved UHC Medicare Advantage



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I am so impatient. I just called UHC and asked about my prior auth and she said I was approved as of 4/30. I called Anita, my insurance nurse, and left her a message. I'm so excited and hoping now some of my anxiety and stress will diminish.

For stats if anyone is wondering, this was my process:

*6 mo physician supervised diet/exercise

*5 years of BMI (didn't have to be over 35)

*my co-morbids are osteoarthritis, GERD, borderline DM, borderline hypertension, borderline high cholesterol

*my submitted BMI was 37 (I maintained my weight for 6 months, didn't try to lose weight)

*cardiac clearance

*psych clearance

**didn't need sleep clearance because I don't have apnea

Started process in November 2018

Final clearance was 4/16

Submitted to UHC on 4/19

Approved by UHC on 4/30 with no denials

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PreOp diet starts 5/14
Surgery is 5/28
Wow!! That 6 mo actually flew by.

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CONGRATULATIONS!!!!!! So happy and relieve for you! Must feel good.

Waiting for mine, fingers, toes and eyes crossed!!🤞

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Thank you!! I’m relieved, slept better last night. Good luck!! 🤞🏼🤞🏼

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Thank you!! I’m relieved, slept better last night. Good luck!! 🤞🏼🤞🏼
Thank you! Please keep us updated about surgery and all! Good luck and well wishes.

Sent from my SM-N960U using BariatricPal mobile app

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Hello LLane RN, how are you? And how is preop diet going? I bet you are at the edge of your seat!

I just wanted to give you my update. I too got my approoval today and I could not be happier!!

I met surgeon first time 4/24 to have my lap band removed after 7 years od bondage (not all bad, but felt like it). I was disappointed to find that my surgeon would not do the revision simultaneously...but now I am glad she did not as I have had the chance to not go off how I was feeling with the labpband and do some very necessary research both on the site and generally. I did tell the office to go ahead an submit as I did not want a long wait and wanted to know my faith early on in the process.

Request was submitted initially on 4/30 but they had the wrong CPT code and it was resubmitted immediately and we waited 1 week to come find out the new CPT code request was also cancelled same day. So they resubmitted again on 5/13 and they made me wait exactly 2 weeks to hear back today as yesterday was a public holiday that the request was approved.

I met surgeon once, lap band removed on 5/3 and approval today. I am yet to meet the Nutritionist, Psych etc.

I plan to still do all that but it feels good to know the approval is in and I can do all other appointments at my leisure.

Thanks to your encouragement and this site for all the GOLDEN nuggets, it was invaluable.

Good luck to you LLaneRN, I'll be praying that your surgery goes very well and your recovery is speedy!

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I too have the same ins. I am on month 4 of weight loss visits, had the psych exam, upper gi, join support group, ekg.

My doc did the same way. He knew what uhc required.

Thanks for the reassurance!

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On 5/2/2019 at 1:47 PM, LLaneRN said:

I am so impatient. I just called UHC and asked about my prior auth and she said I was approved as of 4/30. I called Anita, my insurance nurse, and left her a message. I'm so excited and hoping now some of my anxiety and stress will diminish.

For stats if anyone is wondering, this was my process:

*6 mo physician supervised diet/exercise

*5 years of BMI (didn't have to be over 35)

*my co-morbids are osteoarthritis, GERD, borderline DM, borderline hypertension, borderline high cholesterol

*my submitted BMI was 37 (I maintained my weight for 6 months, didn't try to lose weight)

*cardiac clearance

*psych clearance

**didn't need sleep clearance because I don't have apnea

Started process in November 2018

Final clearance was 4/16

Submitted to UHC on 4/19

Approved by UHC on 4/30 with no denials

Hey there LLaneRn,

I have UHC advantage plan as well. However, they have told my surgeons office that no prior authorization is required?! They had you go through a prior authorization process? I hope that their not trying to just hang me with an outrageous bill 😩

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16 hours ago, Mrs.RNBSN said:

Hey there LLaneRn,

I have UHC advantage plan as well. However, they have told my surgeons office that no prior authorization is required?! They had you go through a prior authorization process? I hope that their not trying to just hang me with an outrageous bill 😩

Medicare doesn't require a prior auth but UHC does, even if they're a medicare advantage plan. Your insurance nurse will likely send in everything anyway to obtain a prior auth because they want to make sure they'll get paid. I would just tell the insurance nurse to send it for a prior auth anyway, even if they said it's not required. At least then you have a leg to stand on if they try to deny the claim post op. Also, if they insist a prior auth is not needed then get it in writing. I called UHC several different times and was told something different by each person I spoke to. My surgeon's insurance nurse told me that everyone requires a prior auth except straight medicare patients, they just have to cross their fingers that it's approved after surgery takes place. Hope that's helpful. Good luck!!

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On ‎5‎/‎29‎/‎2019 at 12:44 AM, Deedee12 said:

Hello LLane RN, how are you? And how is preop diet going? I bet you are at the edge of your seat!

I just wanted to give you my update. I too got my approoval today and I could not be happier!!

I met surgeon first time 4/24 to have my lap band removed after 7 years od bondage (not all bad, but felt like it). I was disappointed to find that my surgeon would not do the revision simultaneously...but now I am glad she did not as I have had the chance to not go off how I was feeling with the labpband and do some very necessary research both on the site and generally. I did tell the office to go ahead an submit as I did not want a long wait and wanted to know my faith early on in the process.

Request was submitted initially on 4/30 but they had the wrong CPT code and it was resubmitted immediately and we waited 1 week to come find out the new CPT code request was also cancelled same day. So they resubmitted again on 5/13 and they made me wait exactly 2 weeks to hear back today as yesterday was a public holiday that the request was approved.

I met surgeon once, lap band removed on 5/3 and approval today. I am yet to meet the Nutritionist, Psych etc.

I plan to still do all that but it feels good to know the approval is in and I can do all other appointments at my leisure.

Thanks to your encouragement and this site for all the GOLDEN nuggets, it was invaluable.

Good luck to you LLaneRN, I'll be praying that your surgery goes very well and your recovery is speedy!

I had surgery on 5/28. No pain, no hunger, no issues at all. I feel great and am currently 3 weeks post op. I'm getting plenty of exercise and have am in the pureed stage of foods. I hope all goes as planned and smoothly for you. hugs

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Congratulations!! I'm so glad to hear everything is going well! I've been thinking about you and I so appreciate the update and can't wait to join you!
Take care and I wish you a very successful weight loss journey!
Hugs.

Sent from my SM-N960U using BariatricPal mobile app

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